ObjectivesThere are concerns that medical pluralism may delay patients’ progression through the HIV cascade-of-care. However, the pathways of impact through which medical pluralism influence the care of people living with HIV (PLHIV) in African settings remain unclear. We sought to establish the manifestation of medical pluralism among PLHIV, and explore mechanisms through which medical pluralism contributes bottlenecks along the HIV care cascade.MethodsWe conducted a multicountry exploratory qualitative study in seven health and demographic surveillance sites in six eastern and southern African countries: Uganda, Kenya, Tanzania, Malawi, Zimbabwe and South Africa. We interviewed 258 PLHIV at different stages of the HIV cascade-of-care, 48 family members of deceased PLHIV and 53 HIV healthcare workers. Interviews were conducted using shared standardised topic guides, and data managed through NVIVO 8/10/11. We conducted a thematic analysis of healthcare pathways and bottlenecks related to medical pluralism.ResultsMedical pluralism, manifesting across traditional, faith-based and biomedical health-worlds, contributed to the care cascade bottlenecks for PLHIV through three pathways of impact. First, access to HIV treatment was delayed through the nature of health-related beliefs, knowledge and patient journeys. Second, HIV treatment was interrupted by availability of alternative options, perceived failed treatment and exploitation of PLHIV by opportunistic traders and healers. Lastly, the mixing of biomedical healthcare providers and treatment with traditional and faith-based options fuelled tensions driven by fear of drug-to-drug interactions and mistrust between providers operating in different health-worlds.ConclusionMedical pluralism contributes to delays and interruptions of care along the HIV cascade, and mistrust between health providers. Region-wide interventions and policies are urgently needed in sub-Saharan Africa to minimise potential harm and consequences of medical pluralism for PLHIV. The role of sociocultural beliefs in mediating bottlenecks necessitate adoption of culture-sensitive approaches intervention designs and policy reforms appropriate to the context of sub-Saharan Africa.

Particular communities and groups of people develop particular prevailing points of view, including how health and illness is understood. Our prevailing points of view, ‘worldviews’ or positioning, are a result of the ‘dialogue’ between us and our wider society (see Creswell 2009:8) and is a process of “active construction” (Fox 2001: 23). As such, we approach reality from our particular point of view which has been constructed and developed over time (see Rosaldo 2003:583). Different societies have in turn, their specific practices and beliefs, as well as their approach to health and illness (see Naidu 2013: 257; Naidu 2014: 147; Vaughn, Jacquez, and Baker 2009: 65). As Whyte, van der Geest and Hordon (2002: 118) assert, many factors “influence people's response to ill-health, including entrenched beliefs”. As such, the understanding and approach to illnesses vary from one society to another, one setting to another, and one belief system to another. This paper looked at what isiZulu-speaking nurses understand by illness and healing. It explored what sickness means to the Ama Zulu African nurses. In exploring this understanding of nurses, the paper explored the wider cultural belief system of the isiZulu-speaking nurses within which their understandings are deeply embedded.

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Background: Undergraduate medical students are trained to acquire a general medical practice overview on qualifying. This training forms a foundation for primary health care service or further training towards a specialty of choice. Objective: The aim of the study was to determine the scope of published scientific literature on the training of undergraduate medical students in “general medical practice” and “primary health care,” exploring how these two concepts are understood, the pedagogical approaches employed by the trainers, the training platforms and the challenges encountered during the training. Methods: The review followed the five steps recommended by Arksey and O’Malley. Using the specified eligibility criteria, the research team systematically screened titles, abstracts, and full articles. Data were entered into Google Forms spreadsheets, which was followed by inductive data analysis of key themes. Results: 130 articles were eligible for inclusion in the study. Thematic analysis yielded eight themes: definition of “general medical practice” and “PHC”, pedagogical approaches (conventional, PBL, teams and CBME), training platforms (tertiary and rural), medical students’ trainers (faculty, GPs and patients), training content, trainers’ and trainees’ perceptions, and challenges encountered. Conclusion: This scoping review has revealed that general medical practice and primary health care are approaches to holistic patient care taught at undergraduate medical training. Primary health care and general medical training are mainly undertaken in GP practices and rural settings. Competency-based medical education is emerging as an appropriate pedagogical method towards ‘fit-for-purpose’ training. The inclusion of patients as trainers in general medical practice and primary health care is yielding positive results.